Ⓜ️ MEDICAL SEARCH TECHNOLOGIES
CFO Dashboard: FWA Medical Insurance Analytics
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Date Range: Q3 2023
Payer: [All]
Payer: [All]
Prior Authorization (PA)
Total PA $:
$215M
Anomaly PA $: $34M (15.8%)
# PA Cases: 145K
Special Investigations (SIU)
SIU Investigated $:
$89M
Anomaly SIU $: $21M (23.6%)
# Open Cases: 4,200
Utilization Management (UM)
UM Total $:
$470M
Anomaly UM $: $56M (11.9%)
# Outlier Cases: 22K
Anomalous Service Categories (Ranked by Anomaly $)
| Category Name | Total Claims | Anomalous Claims (Count) | Total Providers | Anomalous Providers | Total Dollars Involved | Anomaly $ Amount | Anomaly % |
|---|---|---|---|---|---|---|---|
| Pain Management | 21,500 | 6,020 | 315 | 88 | $5,250,000 | $1,470,000 | 28.0% |
| Physical Therapy | 33,600 | 8,400 | 460 | 125 | $4,200,000 | $1,050,000 | 25.0% |
| Imaging | 18,200 | 2,730 | 260 | 42 | $4,800,000 | $720,000 | 15.0% |
Action Items
Review CPT 27447 anomalies for SIU
Assigned: Jane D. • Due: 05/01/2026
Investigate PA spike for Advanced Imaging
Assigned: Mike R. • Due: 05/01/2026
Analyze high risk UM cases for Q3
Assigned: Sarah P. • Due: 05/03/2026
Anomaly Dollar Trend Over Time (Last 6 Months)
[Interactive Trend Chart: $ Anomalies vs Total $ Processed]